Cognitive Therapy Basics

The basic hypothesis of Cognitive Behavioural Therapy, or CBT, is that our emotions are greatly influenced by our cognitions. Or, put in plain English, “we feel what we think”.

Anger is, of course, a very common emotion and as such is not necessarily a problem. Getting angry occasionally can be entirely appropriate – I think we can all empathise with people who are angry because their car’s been stolen or someone’s spreading rumours about them. But anger can get out of hand – either through becoming too frequent or becoming too intense – and this certainly can be a problem.

And with today’s lifestyles anger can seem to be on the rise. Whether or not it is (in reality) increasing, there is certainly plenty anger-related crime reported in the media, perhaps the most obvious being the notion of “Road-Rage”. As a psychiatrist in Edinburgh I see plenty of clients that have some difficulty in controlling their anger. Often the anger appears situational – often being related to a stressful working enviroment – but it can be more generalised as well. And yes, I have seen people with “road-rage”. Even a beautiful city like Edinburgh can’t avoid the rush-hour jams (especially not since the tram-works started…)

When anger is causing an individual problems (in their relationships, occupation, or with the police etc), CBT therapists will often call it “dysfunctional”. The causes of dysfunctional anger – like any other emotional problem such as depression or anxiety – can usually be traced back to the way a person thinks. In CBT parlance, a person exhibiting dysfunctional anger will often show particular “Thinking Errors” that predispose him to anger.

Most people that have anger problems show “Inflexible Thinking”. That is, they live by a varying number of rules that they’ve set for themselves and for others. These rules may not even be obvious to the person, but when they’re broken they will feel intensely angry. An example of a rule might include “People must always drive as well and as courteously as me”. Obviously it would be nice if everyone did drive like you, but they’re not going to, so you’re in for a lot of rule-breaking and hence a lot of anger! A CBT therapist would help the individual to identify this unhelpful rule, and help the person develop a more flexible way of thinking.

Having “Poor Frustration Tolerance” is another feature of dysfunctional anger. People can convince themselves that they can’t stand any discomfort and inconvenience at all, no matter what it is or what the possible benefits in the long run might be. You may really want to see Madonna in concert, but the queue for tickets is “too long” and you “can’t stand” queuing anyway. So you leave in a huff, and then kick yourself repeatedly over the next few weeks as your friends get more and more excited over the upcoming gig! A CBT therapist can help you learn to “frame” inconveniences and discomfort in a less emotive way, increasing your tolerance levels and lessening your self-defeating anger.

People with dysfunctional anger are often in the habit of “Labelling” others. That is, they are in the habit of describing (both to themselves and others) people or situations in just a few words – often just one! So a job is “irritating” and a work colleague “annoying”. Whilst such a way of thinking and talking scores points for brevity, it must surely be inaccurate – is every aspect of the job “irritating”? Is the work colleague always, 100% “annoying?” Probably not. By labelling situations and people in such a way you can predispose yourself to anger problems as these situations and people are always in your “bad books”, regardless of what they do. So a minor slip up here or there and you’re primed to jump down their throats. A CBT therapist will endeavour to help you regard other people and situations as more complex than this, allowing them (and you) room for error without causing anger.

The above thinking errors are those that I’ve most commonly encountered whilst working as a therapist in Edinburgh. CBT is an effective psychological treatment for a whole host of psychological and emotional problems, ranging from Anorexia to Trichotillomania.

Dr Steve Last is a Psychiatrist who uses CBT techniques. He is based in Edinburgh. Please visit http://www.drstevelast.co.uk for further information about psychological problems and CBT.



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Cognitive Therapy was initially developed as a treatment for depression by Psychiatrist Aaron T Beck. It has now become popular for the treatment of a wide range of psychological disorders.



Its guiding principle is that while we cannot control what life throws at us we can choose how we react to the situation or event. Beck believed that   we can change how we feel by changing what we think. The CBT therapist will focus primarily on the here and now and not so much on past issues.

People with Eating Disorders tend to have distorted thinking in relation to food and body image.

Typical Bulimic thoughts might be:

“I ate a bag of chips today and I feel like I have gained 5 inches on my hips”

I shouldn’t have eaten that Chinese take away now I have to throw it up”

I will only eat breakfast today so I can lose the extra fat I put on yesterday.

I know I look huge in these jeans and no one can tell me any different, I have to get down to a size 6 and then I will feel happy”.

If I lost 10 more pounds he will love me”

These examples illustrate that a negative thought  is instantly translated into feeling fat.

The challenge for the person with Bulimia is to become more aware of your negative self beliefs.

Identify how these negative thoughts are making you feel (i.e. shame, guilt, anger, sadness) and how these feelings can lead you to a binge.

This is the Thought/ Feeling /Behavior cycle.

People with Eating Disorders tend to have other related difficulties in their life such as anxiety, depression, communication problems (social phobia), high stress levels and unexpressed anger. CBT can help to resolve these problems effectively.

CBT is not a magical cure and does involve the person with the problems becoming actively involved in the therapy. People coming for therapy for the first time tend to think that the model of therapy or the therapist is going to do all the work.

One of the major benefits of CBT is increased Self esteem:

Working with Self Esteem in CBT will involve focusing on the following:

Self awareness- becoming more aware of thoughts, feelings and behaviour.

Self acceptance- positive as well as negative aspects of the self.

Self care- recognising and meeting own needs.

Self protection- avoiding dangerous situations.

Self reliance/trust- making own decisions.

Self Assertion.

Self responsibility- taking responsibility for own actions.



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Cognitive Behavioural Therapy, or CBT, is an effective psychological treatment for a wide range of psychological and emotional problems. As a psychiatrist based in Edinburgh who uses CBT techniques, I see a lot of clients suffering from depression. A prominent feature of their symptom profile is the presence of “Depressive Ruminations”.

The term “rumination” relates to a repeated cycle of activity – in the case of cows (”ruminants”), this means chewing the cud! In CBT circles, ruminations are the repeated, seemingly endless, “stuck” ways of thinking seen in certain psychological conditions. It is particularly common in depression.

There can be many “themes” to an individuals ruminations, but the most common is a search for some sort of answer to questions such as “Why am I feeling like this?” or “What could I have done to avoid this?”. Another common theme is one of remorse or regret – “If only I had done (whatever) differently I wouldn’t be in this position now” or “I’ve ruined my life”. Depressive ruminations about the future are also seen – “Everything’s going to go wrong”. Ruminations often incorporate what a CBT therapist would call “Thinking Errors”.

What does it feel like to ruminate? Well, I’m sure we’ve all done it at one time or another! It’s like trying to solve an unsolvable riddle – you just go round and round inside your head, examining the same old “clues”, time and time again. If only you’d done this, or said that, or had this, or not had that. You convince yourself that there’s an answer, and that when you find it then you’ll be fine. But of course there is no “answer”. People can ruminate for hours in severe cases, but up to an hour is more usual.

How do you know when you’re ruminating? Because you’ve stopped doing everything else! You haven’t turned the page of your book for the past 20 minutes, or you’re standing in the kitchen with a dishcloth in your hands, gazing off into space. If someone asks you what you’ve been thinking, you can bet it’s the same old depressive thoughts that you’ve been carrying around for ages.

Is there a problem with ruminating? Well, yes. It differs from other forms of thought such as problem-solving, or reflecting, or remembering, in two ways. Firstly, most people find it rather unpleasant. The same old worries getting churned up again and again are bound to make us feel sad or anxious. Secondly, rumination tends to worsen (or at least maintain) depression – if you focus on how bad you feel and how hopeless (you feel) your situation is, then you will ignore opportunities for change.

CBT theory sees depressive ruminations as a major obstacle to recovery from depression, and as such it is important for clients to learn how to deal with them. There are a range of techniques, but the ones I favour as a therapist in Edinburgh are both simple and effective (and almost common sense!).

If you realise you are ruminating, then now’s the time to do something energetic. It’s hard to ruminate when you’re out on a run, or swimming, or doing press-ups. The pain tends to get in the way! Or, if you’re not the exercise type, try refocusing your attention. Focus (really focus hard!) on some aspect of your surroundings – a picture on the wall, a tree, the cat – and examine it for detail, noting each and every irregularity and shade of colour. Pretend that you’re a famous artist and that you’re going to paint the most brilliant, detailed, lifelike picture ever! Really focusing on things outside of you (meaning “outside of your head”!) helps to dislodge your thinking from ruminative patterns. A final tactic – one that some clients swear by and others can’t get the hang of at all – is to “stand-back” (”in your head”, as it were!) and let your thoughts simply churn away to themselves, whilst acknowledging them as pointless symptoms of your depression. By letting them “get on with it”, and refusing to “play with them”, you disarm them of their depression-causing capability – eventually they’ll get bored and go away!

The above techniques are those that I’ve found most effective working as a CBT therapist in Edinburgh. There are a number of other methods out there in the literature, and I don’t claim that these work for everybody. A good thing about the CBT ethos is that it shies away from doctrinal doings – there’s no “You have to do it this way or else!” in CBT. So the bottom line is, use whatever method you find helps you the most, and say “Goodbye!” to those unpleasant ruminations!

Dr Steve Last is a Psychiatrist who uses CBT techniques. He is based in Edinburgh. Please visit http://www.drstevelast.co.uk for more information about psychological problems and CBT.



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The basic tenet of Cognitive Behavioural Therapy, or CBT, is that what you think affects the way you feel. That is to say, if you think depressive thoughts then you will feel depressed. Conversely, if you manage to stop yourself thinking these thoughts, then your depression will lift.

As a psychiatrist using CBT techniques, my first step is to look for unhelpful patterns of thinking with my clients. Depressed people often think in particular ways that are very different from non-depressed people. These ways of thinking are called – in CBT language – “thinking errors”. Thinking errors help to cause and then maintain depression.

Numerous different thinking errors have been identified by CBT therapists over the years, and particular kinds of errors seem to predispose to particular psychological problems. In my experience as a therapist, the most common errors found in depression are “All-or-Nothing” thinking, “Mental Filtering”, “Disqualifying the Positive”, and “Personalising”.

“All-or-Nothing” thinking (also known in CBT circles as “Black-or-White” thinking) emphasises extremes and ignores the fact that most things in life are shades of grey rather than absolutes. For example, a person thinking in this way may play one poor game of tennis and then decide that he’s totally useless and give up forever. Or she may miss one yoga class and tell herself that as she’s fallen behind, there’s no point in going back. “All-or-Nothing” thinking sets very rigid rules for a person to live by – rules that, if broken (as they almost inevitably are!) can lead to the abandonment of enjoyable and worthwhile activities, and predispose the person to depression.

“Mental Filtering” is the term applied to the thinking patterns of people who “see” the world in a depressive way. People with this thinking error are biased in what they take notice of, and what they later remember. They will tend to notice (or, in CBT parlance, “attend”) to objects, people, or events that “fit-in” or confirm their previously held beliefs. For example, a depressed person who thinks that the world is an unpleasant place to live is more likely to remember the sad news stories as compared to a non-depressed person. A depressed person who thinks that they’re unlikeable will take extra notice of possible sleights from others. CBT theory posits that such mental filtering reinforces a person’s depression.

A closely related thinking error is termed “Disqualifying the Positive”. As well as focusing on the negative features of the world (and themselves), depressed people will often actively ignore (or “disqualify”) evidence to the contrary. A depressed person may well recall the person at the party who ignored them, but he will forget or downplay the others who chatted to him for hours. If a CBT therapist asked them about this, he will often say things like “oh, they just felt sorry for me”, thereby turning a positive interaction into something very different.

“Personalising” is the term given to a type of thinking that places the person at the centre of events. Such a view of the universe places a huge burden on the persons shoulders – they can feel responsible for all the bad things that happen. You may be “Personalising” when you feel guilty about not being able to help an unemployed friend keep his house, or when reading about climate change due to our Western way of living. There are factors beyond your control and for which you should not take responsibility. If you do, then CBT hypothesises that you will experience feelings of guilt, shame, and ultimately depression.

The above is a brief review of the common thinking errors that I have come across during the course of my work as a therapist in Edinburgh. Identifying such errors with the client is a first step on the way to identifying other, healthier, ways of thinking.

Dr Steve Last is a Psychiatrist who uses CBT techniques. He is based in Edinburgh. Please visit http://www.drstevelast.co.uk for further information on psychological problems and CBT.



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The basic tenet of Cognitive Behavioural Therapy, or CBT, is that what you think affects the way you feel. That is to say, if you think depressive thoughts then you will feel depressed. Conversely, if you manage to stop yourself thinking these thoughts, then your depression will lift.

As a psychiatrist who uses CBT techniques, my first step is to look for unhelpful patterns of thinking with my clients. Depressed people often think in particular ways that are very different from non-depressed people. These ways of thinking are called – in CBT language – “thinking errors”. Thinking errors help to cause and then maintain depression.

Numerous different thinking errors have been identified by CBT therapists over the years, and particular kinds of errors seem to predispose to particular psychological problems. In my experience as a therapist, the most common errors found in depression are “All-or-Nothing” thinking, “Mental Filtering”, “Disqualifying the Positive”, and “Personalising”.

“All-or-Nothing” thinking (also known in CBT circles as “Black-or-White” thinking) emphasises extremes and ignores the fact that most things in life are shades of grey rather than absolutes. For example, a person thinking in this way may play one poor game of tennis and then decide that he’s totally useless and give up forever. Or she may miss one yoga class and tell herself that as she’s fallen behind, there’s no point in going back. “All-or-Nothing” thinking sets very rigid rules for a person to live by – rules that, if broken (as they almost inevitably are!) can lead to the abandonment of enjoyable and worthwhile activities, and predispose the person to depression.

“Mental Filtering” is the term applied to the thinking patterns of people who “see” the world in a depressive way. People with this thinking error are biased in what they take notice of, and what they later remember. They will tend to notice (or, in CBT parlance, “attend”) to objects, people, or events that “fit-in” or confirm their previously held beliefs. For example, a depressed person who thinks that the world is an unpleasant place to live is more likely to remember the sad news stories as compared to a non-depressed person. A depressed person who thinks that they’re unlikeable will take extra notice of possible sleights from others. CBT theory posits that such mental filtering reinforces a person’s depression.

A closely related thinking error is termed “Disqualifying the Positive”. As well as focusing on the negative features of the world (and themselves), depressed people will often actively ignore (or “disqualify”) evidence to the contrary. A depressed person may well recall the person at the party who ignored them, but he will forget or downplay the others who chatted to him for hours. If a CBT therapist asked them about this, he will often say things like “oh, they just felt sorry for me”, thereby turning a positive interaction into something very different.

“Personalising” is the term given to a type of thinking that places the person at the centre of events. Such a view of the universe places a huge burden on the persons shoulders – they can feel responsible for all the bad things that happen. You may be “Personalising” when you feel guilty about not being able to help an unemployed friend keep his house, or when reading about climate change due to our Western way of living. There are factors beyond your control and for which you should not take responsibility. If you do, then CBT hypothesises that you will experience feelings of guilt, shame, and ultimately depression.

The above is a brief review of the common thinking errors that I have come across during the course of my work as a therapist in Edinburgh. Identifying such errors with the client is a first step on the way to identifying other, healthier, ways of thinking.



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